Friday, May 31, 2013

MS: With the apparent ongoing demise of the capitalist state, many people are looking at other ways to be successful, to run their lives, and I’m wondering what you would say anarchy and syndicalism have to offer, things that others ideas — say, for example, state-run socialism — have failed to offer? Why should we choose anarchy, as opposed to, say, libertarianism?

NC: Well what’s called libertarian in the United States, which is a special U. S. phenomenon, it doesn’t really exist anywhere else — a little bit in England — permits a very high level of authority and domination but in the hands of private power: so private power should be unleashed to do whatever it likes. The assumption is that by some kind of magic, concentrated private power will lead to a more free and just society. Actually that has been believed in the past. Adam Smith for example, one of his main arguments for markets was the claim that under conditions of perfect liberty, markets would lead to perfect equality. Well, we don’t have to talk about that! That kind of —

MS: It seems to be a continuing contention today …

NC: Yes, and so well that kind of libertarianism, in my view, in the current world, is just a call for some of the worst kinds of tyranny, namely unaccountable private tyranny. Anarchism is quite different from that. It calls for an elimination to tyranny, all kinds of tyranny. Including the kind of tyranny that’s internal to private power concentrations. So why should we prefer it? Well I think because freedom is better than subordination. It’s better to be free than to be a slave. Its’ better to be able to make your own decisions than to have someone else make decisions and force you to observe them. I mean, I don’t think you really need an argument for that. It seems like … transparent.

The thing you need an argument for, and should give an argument for, is, How can we best proceed in that direction? And there are lots of ways within the current society. One way, incidentally, is through use of the state, to the extent that it is democratically controlled. I mean in the long run, anarchists would like to see the state eliminated. But it exists, alongside of private power, and the state is, at least to a certain extent, under public influence and control — could be much more so. And it provides devices to constrain the much more dangerous forces of private power. Rules for safety and health in the workplace for example. Or insuring that people have decent health care, let’s say. Many other things like that. They’re not going to come about through private power. Quite the contrary. But they can come about through the use of the state system under limited democratic control … to carry forward reformist measures. I think those are fine things to do. they should be looking forward to something much more, much beyond, — namely actual, much larger-scale democratization. And that’s possible to not only think about, but to work on. So one of the leading anarchist thinkers, Bakunin in the 19th cent, pointed out that it’s quite possible to build the institutions of a future society within the present one. And he was thinking about far more autocratic societies than ours. And that’s being done….

* Have I mentioned how much I hate the rote introduction “People have [stereotyped image of anarchists]. Here’s this anarchist who, you’ll be surprised to learn, isn’t [stereotyped image]”? It’s especially silly when referring to the most famous anarchist alive. Otherwise, worthwhile.

“It is the responsibility of intellectuals to speak the truth and to expose lies. This, at least, may seem enough of a truism to pass over without comment. Not so, however. For the modern intellectual, it is not at all obvious.” – Noam Chomsky

What’s shocking is, well, first, that Nugent would even ask the second question, and, next, that after he pretty much answers Yes to the first,* he leans toward Yes in response to the second. I hope I don’t even have to spell out why this is a terrible position. The idea of the “Noble Lie” is inherently authoritarian, contrary to every standard of epistemic and democratic ethics. When it comes to biopsychiatry specifically, the suggestion that there’s anything positive about the promotion of this scientifically invalid model is laughable. Nugent provides an autobiographical note, but fails utterly to address the extensive evidence of biopsychiatry’s real harms. In fact, I’m astonished that he could move so breezily from the first to the second question.

His concluding remarks left me nearly speechless:

It seems to me—and I am a novelist, not a mental health professional, and so have no dog in this fight, no drug company consulting gig, no claim on insurance payments to protect— that the DSM’s great purpose should be to curb the exuberance with which enterprising doctors and laymen invent, buy, and sell diagnoses for fun and profit. To be sure, this is a Kissingerian stance: Let’s prop up the dictator with the medals on his chest so long as he keeps the guerillas at bay. But if the DSM ceases to be the sourcebook doctors and patients use to determine the parameters of diagnoses, other sourcebooks will proliferate. Like those websites spreading the good news that Nabokov and Dickinson had Asperger’s.

In other words, we should support this brand of authoritarian pseudoscience, even though we know it’s dishonest, to prevent scientific anarchy (gasp).** It’s strange on so many levels: The DSM’s purpose in reality is precisely not to curb the invention and marketing of diagnoses, but to lend those invented and sold by drug companies and enterprising psychiatrists – and the project of biopsychiatry itself – a false air of scientific authority. Nugent just ignores this completely. Second, he isn’t even able to come up with a credible hypothetical threat – just a metaphor. Who are these diagnostic guerrillas and why should we fear them more than the politically and economically powerful corporate psychiatry we have now? (His one example makes his argument even more bizarre: the sites speculating that these famous people had Asperger’s are the outgrowth of biopsychiatry, not alternatives to it.)

But most important, even if we assumed – contrary to the facts - that there were no reasonable, humanistic, evidence-based alternatives, how could anyone possibly think that condoning and promoting dishonest, self-interested, profit-driven pseudoscience is a good idea? Over the past few years, I’ve been perplexed by people’s reluctance to examine the evidence about biopsychiatry. I’ve been surprised by their lack of outrage when they do recognize serious problems. But I never thought I’d see a writer basically acknowledge that biopsychiatry is and has long been a lie, placidly accept this fact, and then proceed to defend the lie. Kissingerian, indeed.

* There are several problems with Nugent’s attempt to answer the first question, beginning with his narrowed focus, typical of many recent articles, on the books by Greenberg and Frances (both apparently interested in saving psychiatry from itself) and his failure to cite the wave of articles and books over the past few years fundamentally challenging the model. Nugent, like so many others, doesn’t really seem to care very deeply about whether or not these diagnoses and this model are false, about whether psychiatry is dishonest. Even when he discusses probably the most obvious and obviously harmful example of corruption – Joseph Biederman - he breezes right past it with little evident concern.

** Nugent doesn’t appear to appreciate that he’s not actually sympathetic to Frances’ position here, because what he’s describing isn’t Frances’ position. I haven’t read his book, but it’s plain from Frances’ other public writings and statements that he believes that at the core of biopsychiatry is truth – he thinks that about 5% of the population (of the US or the entire world, I’m not sure) has a “real” mental “disorder.” He opposes “diagnostic expansion,” but this isn’t the same as an admission that biopsychiatry is based on a false model. But only if you recognize that it is can you talk about the benefits, drawbacks, and ethics of deception, as Nugent does.

(Frances is an interesting case. In this recent Al Jazeera interview, he seems to dodge the questions about the scientific basis for psychiatric diagnoses. He refers to them here and elsewhere as “constructs,” but leaves the implication hanging that the constructs capture a physical pathology, which is precisely the point in contention. It’s just impossible to tell how much of this is evasiveness and how much self-delusion.)

As I’m writing at the moment about mysticism and animals, I read the book with a question constantly appearing in the back of my mind.* I wondered what this book would look like if written by an author who wasn’t raised in Jewish and Christian cultures. Like Erich Fromm’s, Lispector’s mysticism can be seen to challenge and even reject religion. At the same time, though, religion has shaped the mystical experience itself. In order to understand it fully, we have to appreciate how these beliefs also constitute and limit the challenging vision, the rejection.

What would her mysticism look like if Lispector lived in a Buddhist or animist culture? More to the point, what would it look like if she lived in an atheist and scientific culture? What if the mystical experience – the encounter with nonhuman life – occurred within or grew from scientific knowledge about natural history? How does the mystical experience differ if G.H. is an evolutionary biologist?

I suppose some people would argue that the religious beliefs, while they might to some extent distort the mystical experience, are necessary to it. In this prejudiced view, mystical experience is the child of religion, and a genuinely atheistic-scientific mysticism is impossible by definition or destined to be shallow and constricted. I don’t believe this is true, and I’ll have more to say about it in future posts.

* To be clear, this is a question occasioned by the book - not a criticism.

Wednesday, May 29, 2013

“What at first might appear to be exclusively an animal abuse issue is, on closer inspection, clearly also a freedom of expression issue, a workers’ rights issue, an environmental issue and a public health issue,” said Vienna Colucci, Director of Policy at Amnesty International USA.

Will Potter reports on this development, the millions-strong March Against Monsanto, and the North Carolina ag gag bill.

Monday, May 27, 2013

How depressing to reach the end and learn that he’s going to Harvard Divinity School and plans to become a Unitarian minister. I’m saddened that DeChristopher doesn’t seem to know much about the history of nonreligious (including antireligious) social and environmental justice movements. If he did, he’d realize that understanding that moral, psychological, and existential problems are at the heart of our destruction of the environment does not have to point you towards religion.

As annoying as that was, it was their response to Smith that revealed the depth of the problem at CP. It’s all there: the smug, dismissive tone; the cries of “Censorship!” (particularly galling given that they refused to publish Smith’s critical piece, despite the fact that she’s been a regular contributor); the accusations of language policing and “political correctness”; the claim that this is about prudishness; the suggestion that Jolie can’t be inappropriately sexualized because she’s publicly sexualized herself; the refusal to address the actual arguments being made about language;… All the standard bullshit we’ve seen again and again.

I’d like to hope that they’ll come to understand the problem and issue an apology, but given the events of the past few years it’s hard to be optimistic. It remains surprising to me that an organization relying on donations and subscriptions seems happy to alienate a good number of actual or potential supporters.

Sunday, May 26, 2013

I was reminded during the past couple of weeks of the pressing need for a humanistic vision of psychiatry/psychology due to two developments: an upcoming conference about pediatric medicine hosted by…the Vatican, and an article by an author, James Davies, whose book I just recently mentioned here.

The problem isn’t so much these experts participating in the event (although that’s by no means thrilling), though, as what the meeting signifies. With regard to James Davies, prior to posting about his book, I’d noted, but not investigated, a few potentially troubling aspects: that he’d spoken at the Harvard Divinity School, that this book was favorably reviewed by Peter Hitchens, that he’d written a book entitled The Importance of Suffering. So I’ve now had time to look into it, and discovered that, indeed, religious nonsense pervades his thinking.

I was led to reflect that the psychiatric management of despair is premised upon a very different vision of suffering from that which Christianity traditionally professes. In short, psychiatry appeared largely to advance what I would call a "negative model of suffering," while Christianity, in its more traditional forms, seemed to advance a "positive model of suffering."2

The positive model holds that suffering can have a redemptive role to play in human life, that from affliction there can be derived some unexpected gain, new perspective, or beneficial alteration. If this vision of suffering could have its motto, Thomas Hardy captured it well in his poem In Tenebris II: ". . . if way to the Better there be, it exacts a full look at the Worst." The positive vision, thus considered, sees suffering as a kind of liminal region through which we can pass from a worse to a better place. Or alternatively, suffering is a natural outcome of confronting certain unpleasant facts about the human and natural world, facts we may well need to confront if we are to live more firmly rooted in reality.

The negative model asserts quite the opposite view—namely, that little of value can come of suffering at all. It holds that there is no new vista or perspective to be gleaned at suffering's end, nor any insights to be retrieved from its depths. Suffering is thus something to be either swiftly anesthetized or, better still, wholly eliminated, for what good is an experience whose most obvious features are pain and inconvenience?

The positive vision of suffering is at the heart of traditional Christianity. This can be illustrated by the Christian idea of spirit, which is traditionally understood in two generally accepted metaphysical senses: first, as describing an element of God which reaches down to the individual through expressions such as the Holy Spirit; and second, as an element of the individual which reaches up to God for the soul's total purification. In either correspondence (from God to individual or from individual to God), suffering has been regularly acknowledged to play its part, as if very few "summers of divine communion" can be won without a preliminary season of struggle and sorrow. Martin Luther captured this idea well:

God works by contraries . . . a man feels himself to be lost in the very moment when he is on the point of being saved. When God is about to justify a man, he damns him. . . . God's favor is so communicated in the form of wrath that it seems farthest when it is at hand. Man must first cry out that there is no health in him. He must be consumed with horror. This is the pain of purgatory. . . . In this disturbance salvation begins.3

Luther understands purgatory not as a geographical domain lodged between the earthly and heavenly realms, but as a stage or period of human life during which we become conscious of the flawed portions of our humanity—a stage which is inherently painful, because to overcome our defects we must first see them, and seeing them hurts….

Davies calls the negative biopsychiatric vision the heir of the Enlightenment, in contrast to the positive vision characteristic of Christianity. The negative vision maintains that “emotional suffering does not facilitate, but rather impedes human advancement” and needs to be managed and anaesthetized, while the religious vision holds that that “suffering is implicated in our moral or spiritual advancement” – some portion of it “purposeful, ennobling, holy, or transformative.” (Amusingly enough, Davies finds that in practice biopsychiatry and religion are wholly compatible, both being authoritarian and all.*)

There’s a kernel of truth to the first part: biopsychiatry is the inheritor of certain problematic aspects of “scientific” thinking. The “positive” Christian vision is, frankly, blather, and dangerous blather at that. (The part about being rooted in reality is breathtakingly funny.) And the suggestion that these are the only options is absurd. In reality, both the religious and the biopsychiatric visions of human suffering are false, harmful ideologies.

Psychiatry is collapsing, probably (hopefully) sooner rather than later. This is inevitable: it’s pseudoscience. The danger is that religion and other forms of woo see an opening to exploit. If biopsychiatry is the only alternative to a “spiritual” vision of human problems, and it fails, the field is open for religion. And this “positive” vision of suffering is an equally useful ideological accompaniment to neoliberalism and empire. The happiness, the lives, of millions of people are at stake. We have a choice. We need, at this moment more than ever, a clear secular-humanist vision of psychology that avoids the traps of both religion/woo and psychiatric pseudoscience.

We can pursue a humanistic path, which understands human psychological suffering in existential and political terms; which doesn’t superstitiously celebrate, demonize, or pathologize it; which seeks to develop social policies, movements, and arrangements that foster joy and relieve suffering. Or we can turn to the authoritarian superstitions of biopsychiatry or religion.

* “Another factor challenging the idea that ‘psychiatry always advances secularization’ is that many of the websites I encountered did not see antidepressants as threatening Christianity (as I originally did), but rather as working in league with it, irrespective of how the psychiatric vision of suffering might be contrary to the Christian vision.9 These websites provide theological justifications, if ad hoc, for antidepressants being a manifestation of God's love. Many Christian groups, it seems, are adapting to rather than attacking pharmacological remedies by rearticulating their understanding of medicine in terms that enable adherents to reconcile drug consumption with the religious way of life. Pills may mitigate suffering so prayer can be indulged; doctors can be consulted because medicine is part of God's plan; drugs can enable the severely depressed to quit one's bed and return to the pew. Many churches, therefore, seem to be transfiguring these pills into tools that keep church attendance alive, and do not see them as agents of secularization.”

Saturday, May 25, 2013

I’ve become increasingly angered as NIMH’s reaffirmation of its commitment to biopsychiatry has sunk in, and reading The Body Economic only stoked that anger.

The book’s calls for evidence-based public health policy make the unscientific and ideological nature of the NIMH’s RdoC project all the more painfully evident. The decision to (continue to) pursue this course, shifting millions of dollars away from productive research and interventions, simply ignores the decades of evidence showing that the biopsychiatric model is invalid and leads not to helpful treatments but to ineffective and harmful interventions; it ignores decades of evidence pointing to the social-experiential roots of psychological distress and “madness.” Like austerity plans, it’s being imposed from above without even an attempt to justify it scientifically and against the vocal opposition of many of the people most directly affected.

And the fact that the government agency responsible for investigating and responding to psychological problems is declaring that the roots of these problems lie in individual people’s brains amounts to a political statement and a political project. As Stuckler and Basu discuss, there’s strong evidence – not that this should be a surprising or controversial claim – of the devastating impact of homelessness, poverty, economic insecurity, and the fear and stress caused by joblessness in regimes of austerity on people’s mental well-being (in addition, of course, to their physical well-being). More generally, the evidence for social-political factors, and especially victimization, in psychological problems is overwhelming.* Stuckler and Basu provide the data showing that austerity plans cause substantial increases in suicides, for example, while well-designed social protection programs prevent and even reduce them. Insel’s denial of this reality and his determination to try to locate the source of distress in people’s brains amounts to an apology for systemic problems and failures. It’s a project about propaganda – not science or public health.

…[Bruce] Cuthbert [director of the division of adult translational research at NIMH] says that the NIMH is already working on ways to build “crosswalks” between the DSM-V and its new RdoC diagnosis system, which is still barely sketched out.

Why change at all? Cuthbert gives the example of one symptom of depression called anhedonia, the scientific name for inability to find pleasure in normally enjoyable activities. On the one hand, this condition occurs in lots of psychiatric illnesses, including anxiety and eating disorders. We don’t know if it is neurologically similar in all of them or not. On the other hand, there are different types of anhedonia, Cuthbert says. Some people might go out to dinner with friends and not enjoy it. Others might be so down as to lack the energy to get to the restaurant in the first place, even though they would enjoy it once they arrived.

The NIMH’s strategy with the RDoC approach is to dis-entangle a diagnosis like this. If there were a protein or blood test or brain scan that fit with one type of anhedonia (people with eating disorders who are too tired to go out for instance), but not with the others, it doesn’t want to miss it. But this means taking the DSM-5 apart and re-assembling it through arduous experimental work. “It’s going to take a decade or more for results to bear fruit,” Cuthbert says.

Of course, it’s never going to bear fruit, and it takes a high level of willful ignorance to believe that it would. But aside from this, it’s just so inane. Reading the human stories in the news and in The Body Economic - especially the tragic and iconic story of Dimitris Christoulas - we can start to understand the political and existential meaning of suffering. Or we can do decades of silly research to find the proteins responsible for different types of not-wanting-to-go-out-to-dinner. Inane.

It’s available now in the UK (here’s some media coverage), but it looks like we in the US can’t get it until August, which is aggravating.* You can read a sample at the Amazon page, though, which I recommend. I look forward to reading it.

*The subtitle in the UK is Why Psychiatry Is Doing More Harm than Good. In the US, it’s The Unhappy Truth about Psychiatry. No idea why.

At the end of that post I mentioned that I was going to read it right away, and I now have. Tremendous book, and highly recommended for everyone. (The only topic I think could have been examined more relates to the “democracy option.” Stuckler and Basu advocate for democratic, science-based decisions about health policy. They don’t talk in enough depth, though, about the direct health implications of democratic participation vs. austerity. Austerity programs, as the book suggests at various points, involve not only cutbacks but punitive, scapegoating, authoritarian social relations, and these relations themselves have direct and detrimental effects on human well-being.)

It’s interesting, but not really surprising, that the skeptical movement, a significant component of which is ostensibly dedicated to science-based medicine, seems indifferent to these urgent questions. The misery and death caused by austerity plans around the world (in addition to their utter failure in terms of the economic achievements their proponents disingenuously claim for them) are extremely well documented, as are the clear benefits of investing in public health and social protection. The implications for policy are plain. So why aren’t the champions of science-based medicine taking up this cause?

Wednesday, May 22, 2013

My lasttwo shut-up-and-listen posts have discussed epistemic injustice and the practices of hearing as they relate especially to women and to people in the Global South. Maybe no group* right now, though, is more victimized by epistemic injustice than those labeled “mentally ill.” Even people who – mistakenly, as the evidence unequivocally shows – believe that psychiatric labels aren’t stigmatizing in some vague unspecified way would find it difficult to sustain the claim that these labels aren’t legally and politically disempowering. Possibly no one at present is more harmed by testimonial injustice. People so labeled are subject to involuntary confinement and forced interventions in violation of their human rights. They’re politically discredited, often losing confidence in themselves as information-givers. Their experiences are discounted and depoliticized, and even their refusal to accept a false label is treated as a symptom of their alleged pathology. They are very effectively de-voiced.

The recent furore surrounding publication of the new DSM has provided a much-needed opportunity to discuss and debate crucial issues about how we make sense of, and respond to, experiences of madness and distress. Many psychiatrists, psychologists and other mental health professionals have expressed their dismay about the dominance and inadequacy of a biomedical model of mental illness.

They “share these concerns, welcome these debates and support colleagues that are willing to take a stand,” but argue that too often missing from these debates are the people who’ve been labeled with a psychiatric “diagnosis”:

We believe that people with lived experience of diagnosis must be at the heart of any discussions about alternatives to the current system. People who use services are the true experts on how those services could be developed and delivered; they are the ones that know exactly what they need, what works well and what improvements need to be made. This statement outlines the main issues, as we see them, and invites people on the receiving end of a diagnosis to have a voice in this debate.

Their position statement argues that these diagnoses and the model itself are scientifically unsound and harmful, and offers some broad suggestions for alternative approaches. If ever there was a productive moment to shut up and listen to people getting the short end of the epistemic injustice stick, this is it.

At first the whole section seemed somewhat out of place. Peck is trying to confront the reigning human rights interventionist vision with one that takes political and economic self-determination and resistance to imperialism seriously. But the more I considered it, the more I appreciated the epistemic dimension of empire and how fundamental communication rights appear to the realization of all other rights in the global arena.

Recognizing the right to be heard could have profound consequences for imperial projects. I was thinking about this question as I read about the desultory coverage of the genocide trial and conviction of former US-backed Guatemalan dictator Efraín Ríos Montt (in the most depressing news I’ve heard in some time, the conviction was recently overturned by the Constitutional court). FAIR reports:

According to a search of the Nexis news database, some prominent outlets haven't just ignored the U.S. role–they've ignored the story altogether. On the broadcast networks (ABC, CBS and NBC), there have been no references to Guatemala genocide trial at all over the past two months. The Washington Post ran one brief item (5/12/13) about Ríos Montt's conviction .*

A US ally and beneficiary of US support was tried and convicted of genocide. Of genocide. And the major networks in the US didn’t cover the story. (Compare this to the unceasing coverage of the Jodi Arias spectacle.)

How different would public debate in the US about foreign - political, military, corporate, IMF, “humanitarian,” “democratizing,”… - intervention look if the right to be heard were realized in any meaningful way for Guatemalan (and other Latin American and global) victims and social justice activists? Working toward the realization of the right to be heard necessarily involves a collective struggle for institutional change, but as individuals we can practice being virtuous hearers globally the same way we should be locally. We can shut up and listen.

*There appears at first glance (which might be deceptive, of course) to be far more coverage of the overturning of the conviction than there was of the conviction itself.

The cook convened the calf, the suckling pig, the ostrich, the goat, the deer, the chicken, the duck, the hare, the rabbit, the partridge, the turkey, the dove, the pheasant, the hake, the sardine, the cod, the tuna, the octopus, the shrimp, the squid and even the crab and the turtle, who were the last to arrive.

When all were present and accounted for, the cook explained, ‘I have brought you here to ask what sauce you would like to be eaten with’.

One of the invitees responded, ‘I don’t want to be eaten at all’.

The cook then adjourned the meeting.

It’s a fabulous allegory for international power relations and institutions. At the same time, it’s increasingly difficult to use animal allegories without touching the reality of our exploitation of them. Just as I don’t know the Rabbit filmmakers’ views on animal rights, I’m ignorant of Galeano’s (though his sympathetic nature is evident). But as I said about the film, it’s not all that important. People will read works of art in terms of their culture, and as ours becomes increasingly sensitized to the exploitation and suffering of nonhuman animals, these allegories will look increasingly self-incriminating.

By the way, with respect to the “Shut up and listen” meme, I hope it’s clear that it’s the “shut up” part that troubles me, not the “listen” part. Listening is good….

It would seem plain to most thinking people, though, that the two are inseparable. I don’t mean this only in the simple and obvious sense that you can’t really listen while you’re physically talking (though the obviousness of that fact should provide a clue). And listening isn’t just good. Listening – not merely each individual act but the habitual practice of fighting the impulse to impose our perspective and interests and attending to others' experiences and ideas - is an essential element of…inquiry. I would expect the leader of a center nominally dedicated to it to appreciate at least that much.

But this all reminded me of a book I wrote about back in 2011 – Miranda Fricker’s Epistemic Injustice: Power and the Ethics of Knowing. It’s important to recognize that we live and interact in an epistemically unjust culture. What’s at issue is not simply the sexist content of particular beliefs and pronouncements about women and men but the way women and men are treated as information-givers. Outside of Muslim theocracies, testimonial injustice has been to a large extent written out of law, but the culture remains, and is far from confined to religion.

Women are talked at, talked about, talked over, talked past, and talked down to (not to mention monitored, harassed, and threatened when they do speak). Women’s voices aren’t sought. They’re not listened to respectfully, and when they are, they’re not believed and their contributions aren’t incorporated into men’s views. (This is true in relative and absolute terms: when I say that women’s voices aren’t sought, for example, I mean that sometimes they’re not sought at all, sometimes they’re sought less aggressively or as an afterthought, and sometimes they’re sought but to a lesser extent relative to men’s.)

This isn’t a question of a few impolite or insensitive individuals, but is, in Fricker’s words, a “somewhat hidden dimension of discrimination” (p. 145). It’s harmful to women, but also to men – to the entire epistemic community. This epistemic discrimination of course contributes to the false, biased beliefs that emerge and persist, and complements other forms of discrimination. To act ethically as a community, we need to recognize ourselves as part of this epistemically unjust culture and appreciate how it shapes our responses to women as information-givers.

* In relation to helping people understand the structural problem, Fricker talks about the usefulness of thinking about situations in which they’ve been on the “losing” side of epistemic injustice. It’s easier to understand sex-based epistemic injustice, for example, if you can relate it to your own experiences with epistemic injustice as a member of an oppressed racial or ethnic category, and vice versa. Many people have faced it as a young person, or maybe as a low-level employee. I’ve tried in the past to appeal to people like Dawkins or Lindsay (or Peter Singer) by calling attention to parallels with religious privilege, but I recognize that there are significant differences that might render the analogy unhelpful and that it’s possible that some of these men have never been anything but epistemically privileged. In any case, I remain optimistic that people, even if they can’t draw on their own experiences of epistemic injustice, can understand the problem.

I’ve been writing critically about biopsychiatry for a few years now. In that time, I’ve encountered a total of one prominent skeptic who was willing to do the same (as far as I know, following a backlash he hasn’t posted on the subject for two years). In that time, my posts on the subject on atheist-skeptic sites, regardless of context or tone, have been greeted by a barrage of ad hominems (directed at the authors I’m citing or at me) and anecdotes, factually unsupported assertions, and a resolute refusal to investigate the matter further.

If this were just about standing against pseudoscience or manipulation or about being right, or even about more abstract humanistic concerns, I wouldn’t have persistently written about it for the past few years in the face of the onslaught. But it isn’t. The acceptance of this false model has given psychiatry and drug companies unprecedented political power, and people – adults and children – are being coercively and forcibly drugged on a massive scale. In addition to the billions being funneled to pharmaceutical corporations, there have been catastrophic effects on people’s lives. It’s a political nightmare and a human rights disaster.

I’m disappointed that my efforts related to this for the past three years seem to have been almost entirely unsuccessful. The fact that the responses look the same as they did back in 2010 gives me some hope, though. The problem seems at root to be that skeptics aren’t, for some reason, investigating the matter. So all I’ll do right now is provide another list of sources, and urge people in the most heartfelt terms to read and engage with them fairly:

• The new article by Brett Deacon - “The Biomedical Model of Mental Disorder: A Critical Analysis of its Tenets, Consequences, and Effects on Psychotherapy Research”- whose full text is available via my link here (especially the conclusion, Tables 1 and 2, and the references).

If you’re unwilling to read these materials – especially if you continue to post in defense of biopsychiatry - you should turn in your skeptic’s badge. If you read them and don’t come away convinced that what I’ve been saying is true, well, I’ll be surprised, but at least then we could have a real discussion amongst skeptics.

Giles Fraser’s recent article arguing against voluntary euthanasia on allegedly humanistic grounds has provoked hostile responses from many quarters, and rightly so. Ophelia Benson and Eric MacDonald have done an outstanding job of responding to the article’s main thesis. I’m going to expand on these impassioned rebuttals to talk a little more about the vision of human relationships and of love underlying Fraser’s position. His isn’t an especially profound or well-reasoned piece of writing, but I think it’s a useful one to examine since it represents a particular vision of the world, a tragically attenuated one that finds human relatedness primarily or exclusively in pain and defines love narcissistically and coercively. As such, it’s fundamentally at odds with Erich Fromm’s ideal of loving relatedness, and in fact illustrates one of the unhealthy, failed approaches to relatedness that Fromm discusses.

With regard to love, as I’ve discussed, Fromm understood it not as a transitory emotional state but as a general manner of relating to the world. Love as a productive orientation was characterized by care, responsibility, respect, and knowledge.3 My earlier post on the subject discusses this in more detail, but two aspects need to be highlighted again here. The first is that Fromm, as I noted, “stresses the indivisibility of the four basic elements of love: ‘To respect a person is not possible without knowing him; care and responsibility would be blind if they were not guided by knowledge. Knowledge would be empty if it were not motivated by concern’ (27).” The second relevant aspect is the specific meaning of respect Fromm talks about. Respect is based in objectivity – the loving person doesn’t narcissistically project their own understandings and projects onto others. As I said in the earlier post,

It’s a shame that objectivity is so often seen as a detachment from others and the hardhearted treatment of them as objects. That arrogant idea is the opposite of what Fromm’s saying: the objectivity at the heart of love isn’t about being detached from others, but about trying our best in practice to detach our perception of them from our own biases and perceived interests.

For Fromm, caring fundamentally requires humbly seeking to know and understand the wishes of others and avoiding projecting onto them our own wishes and ideas (including our beliefs about what’s best for them).

So an approach to others that respects their autonomous being and development, that doesn’t seek to dominate or exploit them, that refrains from narcissistically imposing our vision and desires is not just rooted in a “liberal” regard for the abstract rights or autonomy of separate, disconnected beings. It’s at the very center of what it means to love others, and therefore of what it means to find real joy and rootedness in the world. Love is joy is ethics.4

Fraser’s vision offers a striking contrast. The experiences and actions of suffering and “sacrifice” he discusses in his article aren’t argued to be pleasurable in themselves. They’re not portrayed (explicitly, at least) as divinely commanded or as paths to a relationship with some god. Rather, he presents them in terms of human relationships and fulfillment. So he attempts to make a secular argument against assisted dying, but in its assumptions and distortions it betrays its flawed and anti-humanist religious origins.

Suffering, death, and authoritarian relations of powerlessness and coercion are Fraser’s proposed means of uniting with the world. The experiences that lead to our immersion in the life of the world are pain, the deterioration of our bodies and the helplessness it brings (“[l]ying in a bed full of our own faeces, unable to do anything about it”), and maintaining others’ dying bodies whether they wish it or not. It’s through these experiences, according to him, that we come to appreciate our shared humanity - how bound our lives are to those of others – and to connect deeply with others. This, to Fraser, is love, and he finds it “extraordinarily beautiful.”

What’s remarkable about Fraser’s view is that these aren’t even just seen as important means of relating to and loving others and creating rootedness in the world – they’re understood as the only means. I think it would be mistaken to read his description of the “liberal” view in favor of assisted dying as an intentional straw man. Fraser’s depiction of the existential situation to which we’re consigned if we don’t relate through pain, suffering, bonds of authoritarianism, and the shared experience of death seems to reflect his genuine belief: that outside these forms of relating there is no real love or connectedness to be found. In his view, it’s only through these forms of relating that we overcome profound, disembodied isolation. Outside of these forms of relating, we regard ourselves – or, at turns, are actually like – “brains in vats… solitary self-defining intellectual identities who form temporary alliances with each other for short-term mutual advantage.” Our connection to others is lost, and we’re alienated from reality.

This reflects an astonishingly narrow vision of what relationships of love and connectedness are. All of the means of productively relating to the world - loving others, healing and caring for and supporting other human and nonhuman animals day to day, cooking and eating together, laughing, creating, enjoying other people’s creations, having and raising children, playing sports, debating, dancing, reading, learning, exploring new places, chatting with strangers, growing plants, making a home, participating in the democratic life of a community, joining with others to fight for what you believe in, observing nature, doing science, listening to music, hiking a trail, sitting on a beach listening to the waves, giving the best of yourself to the world – are denied by Fraser.

His view is also fundamentally contrary to Fromm’s understanding of love as characterized by respect and humility. In Fraser’s vision, there’s no place for personal autonomy or self-determination, or for respecting others’ autonomy and self-determination, in loving relationships; indeed, love is contrasted to “our cherished sense of personal autonomy” and “the liberal model of individual self-determination.” In contrast to a loving orientation that humbly tries to understand another’s experiences and wishes and to care for them in accordance with that understanding, Fraser’s coercively imposes his own understanding and desires: “Shut up about being a burden,” he orders (in his fictional scenario). “I love you. This is what it means to love you.”

Even the act of helping to lessen someone’s “utterly intolerable” pain is portrayed not as an act of humble human friendship or love or even basic compassion but of “mercy.” The use of the word mercy here – a term which suggests an imbalance of power - clearly shows the authoritarian lens through which Fraser views human relations. (And it shouldn’t be forgotten for a moment that his post is an intervention in a debate about the legality of assisted dying. His authoritarian “caring” individual is also the representative of the state, backed by its coercive power.)

When set against Fromm’s expansive vision of active love and the rich possibilities for human relatedness and fulfillment, Fraser’s vision doesn’t appear, as he tries to portray it, as a humanistic alternative to an avoidance of experience and a dry and alienated liberal insistence on abstract rights. It’s revealed instead as an authoritarian project contrary to the very essence of love and based on a pathologically constricted vision of human experience and relatedness. With regard to assisted dying, both in terms of law and our personal relationships, the choice for humanists is between loving, productive, fulfilling relationships and a stunted, unloving, coercive approach that’s destructive to us all.

1 As I’ve alluded to in the past and will discuss in more depth in the future, Fromm wasn’t attuned enough to the ideological sources of alienation. He fully appreciated that – and was at the forefront of analyzing how - capitalism and its culture impede our efforts to realize relatedness. And he did argue that this culture contributes to alienation itself. But he also consistently reinforced the idea that a profound alienation is a fundamental aspect of the human existential condition previous to and transcending culture. (See, among many examples, the first several passages in The Art of Loving.) He didn’t seek to analyze how this idea, this existential understanding of alienation, could itself be the product of culture – of consumerist and managerial capitalism, but also of the highly speciesist religious and philosophical traditions that influenced his thinking.

This unquestioned, culturally-shaped idea of existential alienation is a problem that mars many of Fromm’s arguments, sometimes in insurmountable ways. In this context, it’s necessary to note that, to the extent that Fromm’s arguments about alienation and relatedness proceed from these ideological assumptions, he exhibits some of the same biases as Fraser. While his arguments about relatedness and love can be discussed and contrasted to Fraser’s, as I do in this post, without reference to these assumptions, a comprehensive discussion of alienation and relatedness (which would even more fully reveal the flaws in Fraser’s thinking) has to address this problem.

2 He didn’t argue, though, that pain, grief, and sacrifice were the opposite of joy and happiness or to be avoided at all costs. He saw them as unavoidable aspects of the human experience, and recognized that opening ourselves up to the world in order to experience real joy and happiness necessarily means experiencing also suffering and loss. The opposite of joy and happiness in Fromm’s view was alienation (of which depression was the extreme result) – a condition of not of sadness but of disconnectedness from the world (including ourselves).

3 This discussion wouldn’t have been an abstract one for Fromm, wherever he would have come down on the issue of assisted dying. His second wife was German photographer Henny Gurland. She had a Jewish father, worked as a photojournalist for the German Social Democratic Party, and was an outspoken anti-Nazi activist, and so had flee Nazi Germany and then Nazi Europe. She and her son Joseph and the philosopher Walter Benjamin attempted to escape from France through Spain to the US. They were attacked and caught by Spanish border guards while trying to cross the French-Spanish border on foot. Shot at from planes, Gurland got metal fragments in her side, adding to the pain she experienced from rheumatoid arthritis. After Benjamin’s suicide at the border, the guards allowed Gurland and her son to cross into Spain, and they escaped to the US via Portugal. She and Fromm married there in 1944. He treated Joseph like a son, and cared for her for the rest of her life, including moving to Mexico in the hope that it would improve her health. But she continued to suffer debilitating pain, often leading her to be bedridden, and was deeply depressed. As her health deteriorated, Fromm was caring for her almost full-time. She died in Mexico in 1952, probably from suicide. (This account is from The Lives of Erich Fromm: Love’s Prophet.) Fromm published The Art of Loving a few years later.

4 As Fromm argues in Man for Himself:

The experience of joy and happiness is not only…the result of productive living but also its stimulus…. There is nothing more conducive to goodness in the humanistic sense than the experience of joy and happiness which accompanies any productive activity. Every increase in joy a culture can provide will do more for the ethical education of its members than all the warnings of punishment or preachings of virtue could do. (p. 230)

Wednesday, May 15, 2013

Yesterday, Noam Chomsky and a group Latin America and media experts sent a letter to Margaret Sullivan, Times Public Editor. Here’s the full text without embedded hyperlinks (the text including evidentiary hyperlinks, a list of the relevant Times articles with links and quotations, and information about how to add your name to the petition are available here):

May 14, 2013

Dear Margaret Sullivan,

In a recent column (4/12/13), you observed:

Although individual words and phrases may not amount to very much in the great flow produced each day, language matters. When news organizations accept the government’s way of speaking, they seem to accept the government’s way of thinking. In The Times, these decisions carry even more weight.

In light of this comment we encourage you to compare The New York Times’s characterization of the leadership of the late Hugo Chávez in Venezuela and that of Roberto Micheletti and Porfirio Lobo in Honduras.

In the past four years, the Times has referred to Chávez as an "autocrat," "despot," "authoritarian ruler" and a "caudillo" in its news coverage. When opinion pieces are included, the Times has published at least fifteen separate articles employing such language, depicting Chávez as a "dictator" or "strongman." Over the same period—since the June 28, 2009 military overthrow of elected president Manuel Zelaya of Honduras—Times contributors have never used such terms to describe Micheletti, who presided over the coup regime after Zelaya’s removal, or Porfirio Lobo, who succeeded him. Instead, the paper has variously described them in its news coverage as "interim," "de facto,” and "new."

Porfirio Lobo assumed the presidency after winning an election held under Micheletti's coup government. The elections were marked by repression and censorship, and international monitors, like the Carter Center, boycotted them. Since the coup, Honduras's military and police have routinely killed civilians.

Over the past 14 years Venezuela has had 16 elections or referenda deemed free and fair by leading international authorities. Jimmy Carter praised Venezuela’s elections, among the 92 the Carter Center has monitored, as having "a very wonderful voting system." He concluded that "the election process in Venezuela is the best in the world." While some human rights groups have criticized the Chávez government, Venezuela has had no pattern of state security forces murdering civilians, as is the case in Honduras.

Whatever one thinks of the democratic credentials of Chávez’s presidency—and we recognize that reasonable people can disagree about it—there is nothing in the record, when compared with that of his Honduran counterparts, to warrant the discrepancies in the Times’s coverage of the two governments.

We urge you to examine this disparity in coverage and language use, particularly as it may appear to your readers to track all too closely the U.S. government’s positions regarding the Honduran government (which it supports) and the Venezuelan government (which it opposes)—precisely the syndrome you describe and warn against in your column.

Sincerely,

Noam Chomsky, Institute Professor Emeritus, MIT
Edward Herman, Professor Emeritus of Finance, Wharton School at the University of Pennsylvania
Greg Grandin, Professor of History, New York University
Sujatha Fernandes, Professor of Sociology, Queens College, CUNY Graduate Center
Corey Robin, Professor of Political Science, Brooklyn College, CUNY Graduate Center
Adrienne Pine, Professor of Anthropology, American University
Mark Weisbrot, Ph.D, Co-Director, Center for Economic and Policy Research
Miguel Tinker Salas, Professor of History and Latin American Studies, Pomona College
Katherine Hite, Professor of Political Science, Vassar College
Steve Ellner, Professor of International and Public Affairs, Columbia University, Universidad de Oriente
George Ciccariello-Maher, Professor of Political Science, Drexel University
Daniel Kovalik, Professor of International Human Rights, University of Pittsburgh School of Law
Gregory Wilpert, Ph.D, author of "Changing Venezuela by Taking Power"
Joseph Nevins, Professor of Geography, Vassar College
Nazih Richani, Director of Latin American Studies, Kean University
Steven Volk, Professor of History, Oberlin College
Aviva Chomsky, Professor of History, Salem State University
Keane Bhatt, North American Congress on Latin America
Chris Spannos, New York Times eXaminer
Michael Albert, ZNet
Oliver Stone, Filmmaker, "South of the Border"
Michael Moore, Filmmaker, "Capitalism: A Love Story"

We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.

We haven’t actually been telling people this at all. We and our friends at the pharmaceutical corporations have been leading people to believe for decades that our diagnoses reflected brain disorders for which we had scientific evidence. The chemical imbalance myth? Ours. And we’ve grown rich and powerful in the process. Where would we be if we’d been open all along about how unscientific our diagnoses are?

From Hickey’s:

“We’ve been telling patients for several decades that we are waiting for biomarkers.”

I suggest that this is simply not the case. Psychiatrists have been telling their ‘patients’ for decades that they have chemical imbalances in their brains, that the chemicals involved are known, that the pills correct these imbalances, and that the pills are safe. All of these statements are patently false and extremely destructive. I have never heard (or even heard of) a psychiatrist who said to his [sic] ‘patients’ or to anyone else that “we are waiting for biomarkers.” The entire house of cards has been built on the illusion of scientific certainty, which the psychiatric profession promoted shamelessly.

Of most interest for this post are the two tables it features with quotations from people in the same organizations, and often the same people, claiming at one moment that the model is scientifically valid and admitting at another that it’s not (and that they never really believed it at all). (This reached the height of bad faith in the exchange following Marcia Angell’s two posts in the New York Review of Books, in which two of Angell’s detractors accused her of attacking a straw man by criticizing the chemical imbalance idea while their colleague reproduced it on the same page.)

But the concluding section of Deacon’s article is worth quoting:

…[I]n light of the evidence reviewed in this article, we cannot afford the societal costs of failing to engage in open and honest discussion about the validity and utility of the biomedical paradigm. The predominant approach to mental healthcare in the United States has produced neither clinical innovation nor improved outcomes, and is founded upon tenets that are acknowledged as scientifically premature or even fallacious by some of the very individuals and organizations who promote them…. The quality of care provided to individuals with mental health problems, the societal burden of mental disorder, and the credibility of professionals who treat patients with mental disorders will remain at risk until an honest and public dialogue occurs in response to questions that include, but are not limited to, the following:

• How can mental disorders be considered biologically-based brain diseases, or valid medical conditions, when researchers have not identified any biological variable capable of reliably diagnosing any mental disorder, distinguishing between individuals with or without a mental disorder, or distinguishing different mental disorders from each other?

• How can mental disorders be caused by a chemical imbalance in the brain when scientists lack a baseline standard of what constitutes a chemical balance with which to discern an imbalance, and do not possess a direct measure of neurotransmitter levels in the brain that possesses diagnostic validity or clinical utility?

• Given the historical lack of scientific evidence for the chemical imbalance theory of mental disorder, why have biomedical advocates promoted this story? Why have the APA, NIMH, and NAMI (among others, see Table 1) failed to publicly acknowledge that this story is unfounded? What have been the historical consequences of these actions? How have these actions been influenced by these organizations’ involvement with the pharmaceutical industry?

• If decades of biomedical research have not resulted in the development of clinically useful biological tests, innovative psychotropic medications, or improved mental health outcomes, should billions of dollars of taxpayer money continue to be preferentially allocated to biomedical research? Should zealous advocates of the biomedical model continue to head governmental agencies that determine national research and policy agendas?

• If psychotropic medications are safe and effective, why has the rate of mental health disability risen in close temporal association with their increasing use? Shouldn’t the widespread use of safe and effective psychotropic medications lead to less severe, chronic, and disabling mental disorders, as opposed to the opposite?

• If attributing mental disorder to biologically-based brain disease reduces mental health stigma, why has stigma not improved in the context of widespread promotion and increased public acceptance of the biomedical model?

• If the biomedical model of mental disorder is less valid and psychotropic medications are less effective than is commonly acknowledged, what are the implications for the unique legal authority granted to psychiatrists to involuntarily hospitalize and forcibly treat individuals with mental disorders?

Tennessee Governor Bill Haslam has vetoed a bill that would punish whistleblowers who expose animal welfare, environmental, and workers’ rights abuses on factory farms and slaughterhouses. It’s a huge victory for Tennesseans, but it also has national significance. The tables have turned on Big Ag, and corporate front groups are desperately trying to pick up the pieces of the worst PR blunder in the industry’s history.

Monday, May 13, 2013

I appreciated many of Allen Frances’ criticisms of the DSM-5, and linked here and elsewhere to some of his articles about it. Over time, though, I became more wary. What became increasingly clear was that he wanted to confine his criticism to the new DSM (and, admirably, the one he chaired as well); he continues to be desperately attached to the biopsychiatric model. This is understandable given that his life’s work has been based in this model and his sense of identity and purpose must be bound up with it. But I saw that it was leading him to some arrogant and callous views that I couldn’t in good conscience link to.

In his thinking, a problem is either a brain disorder or nothing. Psychiatric labels have to have biological meaning, so if Binge Eating Disorder isn’t a “real” brain disorder people who would be diagnosed with it must just be gluttons. Either illness or a character flaw. Either “patient” or “worried well.” This is not only false but is precisely the sort of perspective with which critics of biopsychiatry are commonly charged: that if we state that psychiatric diagnoses are scientifically invalid we’re denying the reality of people’s suffering. But I haven’t heard a critic of the brain-disease-drug model – and certainly not anyone from the survivors movement – say anything like this. We recognize distress and suffering and the need for help without any need to identify them with a broken brain. The false choice of disorder or nothing Frances presents is the product of biopsychiatry, not of its critics.

Mental health practitioners and patients are being poorly served by the organizations most entrusted to represent their interests. We have entered a truly remarkable silly season of interacting absurdities committed by the American Psychiatric Association, the National Institute of Mental Health, and the British Psychological Society. May, it turns out, is the cruelest month for mental health.

It started with DSM-5 offering its untested new diagnoses that will mislabel millions of the worried well as mentally ill -- turning our current diagnostic inflation into hyperinflation and distracting attention and resources away from the people who really need help.

Then the NIMH recklessly renounced all syndromal DSM diagnosis as invalid.

This is the point at which he should stop and think. Was it reckless because it was false, or reckless for some other reason? To stop supporting diagnoses that lack scientific validity isn’t reckless. Nor is stating this truth publicly. Quite the contrary: it’s terribly reckless to base interventions in the lives of people experiencing psychological distress on pseudoscience.

You can’t insinuate that the new DSM categories are scientifically invalid while implying that previous ones were mostly or all valid. Frances doesn’t even try to establish the scientific validity of psychiatric diagnoses – which, of course, he can’t. He simply implies a core validity through the use of terms like “diagnostic inflation.”

But NIMH has nothing to offer now in its place except an oversold and undeliverable promise of some future strictly biological model of mental illness that will take decades to deliver -- assuming it can ever be delivered at all.

It can’t be delivered. But of course a biological model of “mental illness” is what Frances’ profession has for decades led people to believe it was delivering, and what their pharma partners have quite literally sold, so this criticism is pretty rich coming from him.

Now the British Psychological Society has produced its own brand of extremist posturing, offering its own quixotic paradigm shift away from the notions that the brain has much to do with mental illness

They’re not useful constructs. More to the point, they’re not scientifically supported constructs. Most people would see that as a serious problem.

Instead mental health problems should be framed primarily in psychological and social terms.

This is all Alice Through The Looking Glass foolishness. The NIMH biological reductionism finds its absurd reflection in the British Psychological Society pscho-social reductionism. Responsible leaders of powerful organizations should know better than to suggest that complicated mental illnesses can ever be reduced to simple and reductionistic answers.

This part is just bizarre. He’s accusing the NIMH of biological reductionism! But the problem with biopsychiatry isn’t that it’s reductionist. It’s that it’s false. That’s an important distinction.

And it’s odd to claim that understanding psychological distress in psychosocial terms is simple and reductionistic. Talking about how our psychology is shaped by our social context and experiences is not only the opposite of reductionistic but is as undeniable as any claim about humans can be. There have been and continue to be reductionistic psychosocial models, and many will be wrong or so incomplete as to be useless, but it shows how far down the biopsychiatric hole we’ve fallen that a psychiatrist could assert in all seriousness that a program of research and care founded in the recognition of the social causes of psychological distress is extremist and a silly dream.

We need a model of mental illness that attends to the biological, to the psychological, and to the social.

That “attends to” is doing a lot of evasive work here. But the full BPS statement is now available; anyone who reads it can see that this is precisely what it advocates (minus the “mental illness” language).

We need leaders who address the current unmet needs of patients -- who are not so enchanted with utopian grand designs for the distant future that they lose interest in the urgent problems of the present.

Every criticism Frances is making of Insel applies to all of biopsychiatry. Again, the claim that a socially oriented psychology is some “utopian grand design” is just laughable. (And stop calling people “patients”!)

DSM-5, the NIMH, and the BPS have all gone far wrong and all for the very same reason -- each has prematurely promised a grandiose paradigm shift when none is remotely possible. Paradigm shifts emerge from new scientific findings -- not from bloviating statements, however well intended.

The chair of the DSM-IV accusing others of grandiosity is a bit much. In any case, this bloviating evades the fundamental issue. Scientific findings do not support the biopsychiatric model. These people have gotten by for a long time with this game. Biopsychiatry’s existence as a “paradigm” and its use of medical language lend it an aura of scientific credibility which is doesn’t possess in reality. Nothing about the availability or quality of alternatives will alter the fact that the diagnoses and the model itself are scientifically unsound.

Patients and practitioners are the collateral damage of this ridiculous controversy. Patients who need help may well lose faith in a mental health establishment that seems so confused and is so confusing.

They should have lost faith in biopsychiatry long ago. For the love of Kraepelin, the model is false. To the extent that the model continues to hold sway in the “establishment” – and I hope the clinical psychologists’ statement is just an important stage in its collapse – it will continue to produce harmful pseudoscience.

It is past time to have just one thing in mind in preparing diagnostic manuals or statements about mental illness that will be widely disseminated. Will this help or hurt our patients' access to quality care?

That is an important question (stop referring to people as patients!). It’s not separable from the scientific question. If a manual or statement or intervention is based on pseudoscience, it’s very likely to hurt people.

So my plea to the American Psychiatric Association, to the National Institute of Mental Health, and to the British Psychological Society -- spare us your empty promises of premature paradigm shifts and instead help us take better care of our patients.

My plea to Allen Frances – acknowledge that, while there are many compassionate, well-meaning people in your profession, good intentions are perverted by the irrational insistence on a failed “paradigm.” The problem goes far deeper than the new DSM. You would do well for people and for your profession if you joined the British clinical psychologists in abandoning it.

Before they attended to the real news - about Prince Harry - Today did a short piece this morning on catastrophic global warming. To offer a contrary perspective, they showed part of an interview with denialist Jay Lehr, introduced by something along the lines of “But not all scientists agree.” Way to cover science, NBC.

Sunday, May 12, 2013

Patients and parents concerned about mental illness have every right to be confused.

Stop referring to people experiencing psychological distress or exhibiting behaviors labeled abnormal or disruptive as “patients.”

The head of the federal agency that finances mental health research has just declared that the most important diagnostic manual for psychiatric diseases lacks scientific validity and needs to be bolstered by a new classification system based on biology, not just psychiatric opinion. The hitch is that such a biology-based system will not be available for a decade or more.

No, the hitch is that it won’t be available. The evidence compiled over the past 50 years leads to no other reasonable conclusion. There is a better possibility that Saddam Hussein’s WMDs are going to turn up. You should question Insel about why he holds such unwavering faith in the biopsychiatric model in the face of several decades of evidence that does not support it.

Dr. Thomas Insel, director of the National Institute of Mental Health, posted his critique of the manual in a “Director’s Blog”on April 29 and expanded on his reasoning in a recent interview with The New York Times. He was critiquing a forthcoming revision of the American Psychiatric Association ’s Diagnostic and Statistical Manual of Mental Disorders, the first major reissue since 1994. Although there have been controversies over particular changes in diagnostic descriptions, he said, the new revision involves “mostly modest alterations” from its predecessor.

This is important. It points to the fact that the problem goes deeper than this edition of the DSM.

The psychiatric association’s diagnoses are mostly based on a professional consensus about what clusters of symptoms are associated with a disease, like depression, and not on any objective laboratory measure, like blood counts or other biological markers. The mental health institute says scientists have not produced the data needed to design a system based on biomarkers or cognitive measures.

This isn’t something the institute “says.” It’s not a matter of opinion – it’s a claim of fact. It’s your job to investigate the truth of that fact claim, not simply to repeat it and then repeat contrary statements and spin. If you were to do so, you would find a hint in David Kupfer’s admission. You would find that he was compelled to make this admission at long last because the reality is that they don’t have the scientific evidence to support their diagnoses. The diagnoses lack scientific validity. The model is not supported by science. That’s quite a shortcoming.

You would also find that all of the hedging spin you typically, lazily repeat does not accord with the truth. The diagnoses aren’t “mostly” based on consensus. They’re not approximations, imperfect, or inexact. The problem isn’t diagnostic inflation or abuse, and it isn’t “overmedication.” It isn’t a lack of training in “proper” diagnosis. The core problem isn’t the medicalizing or misdiagnosing of the “normal.” The problem is that the diagnoses lack scientific validity. The model is not supported by science.

To fill the gap, the agency started a program two years ago to finance research in biology, genetics, neuroscience, cognitive science and other disciplines with the ultimate goal of helping scientists define disorders by their causes, rather than their symptoms.

There is no gap. There is a set of invalid diagnoses based on a false model.

The underlying problem is that research on mental disorders and treatment has stalled in the face of the incredible complexity of the brain.

It hasn’t stalled. Or slowed. Or stagnated. Scientifically, biopsychiatry has been a failure from the start.

That is why major pharmaceutical companies have scaled back their programs to develop new psychiatric drugs; they cannot find new biological targets to shoot for.

There are no old biological targets. There are no biological targets. There are decades of propaganda convincing people that there are biological targets, but there aren’t in fact biological targets.

And that is why President Obama has started a long-term brain research initiative to develop new tools and techniques to study how billions of brain cells and neural circuits interact; the findings could lead to better ways to diagnose and treat psychiatric illnesses, though probably not for many years.

There are better ways to understand and address psychological distress right now. Of course, it isn’t difficult to improve upon a false model. And stop referring to “psychiatric illnesses” and “symptoms” when the whole purpose of your editorial statement is to respond to the growing recognition that there is no scientific evidence of psychiatric illnesses.

Meanwhile, the diagnostic manual remains the best tool to guide clinicians on how to diagnose disorders and treat patients. Consensus among mental health professionals will have to suffice until we can augment it with something better.

Bullshit. Your job is not to prop up biopsychiatry or the pharmaceutical industry. It’s to find and report the truth. It’s bad enough that you’re stragglers in uncovering this epic medical and humanrights scandal. The least you could do at this point is grow some semblance of a journalistic spine.

*OK, I actually think it’s a good and worthwhile paper in many ways. But I’m angry at the moment.

“I believe there is nothing more important that a professional body can do than speak the truth about the evidence – and that is what this statement does.” – Lucy Johnstone

Tomorrow,

the UK Division of Clinical Psychology, a sub-division of the British Psychological Society, will issue a Position Statement…which calls for the end of the unevidenced biomedical model implied by psychiatric diagnosis.

There are twoarticles about this positive development in the Observer, neither of which, unfortunately, is very good and both of which irresponsibly mislead in both their headlines and actual content. Lucy Johnstone’s post at Mad in America (MIA will make the text of the position statement available tomorrow morning) is a better introduction.

The basic position of the DCP parallels my own:

The main difference – and of course it is a crucial one – between the position of these eminent psychiatrists [those who’ve recently publicly acknowledged the lack of validity of psychiatry’s diagnoses] and the DCP is that the former are determined to pursue the biomedical model at all costs. Indeed, NIMH has…announced the intention of launching a 10-year programme to pin down, once and for all, the elusive biomarkers that have evaded researchers so far. The project starts from the remarkably unscientific position of assuming what needs to be proved: in their words that ‘mental disorders are biological disorders.’ Flawed as this enterprise is, it will allow traditionalists to continue to claim that ‘We’re getting there – honestly!’ In the meantime, the overwhelming amount of evidence for psychosocial causal factors is once again relegated to a back seat.

We’re in a moment of extraordinary opportunity. It won’t help to listen to the self-serving claims that abandoning a false, unscientific, and harmful model is dangerous and that there is no alternative. There has long existed an alternative in the form of a radical humanist (or post-humanist) reality-based psychology/psychiatry. While the movement claims no absolute consensus or single direction, there’s a rich tradition of thought and practice to draw from (including but of course not limited to Fromm) that can point the way toward a revolutionary transformation of our understanding of and approach to psychological well-being. It’s an exciting time.

The Amsterdam District Court reviewed the previous decision, yet after consideration upheld the finding that Morgan’s transfer was legitimate. We consider this verdict to be demonstrably legally flawed. The Court based its determination primarily on a surprising appraisal of the ASCOBANS text, finding that a removal of an orca for rehabilitation purposes did not constitute “intentional taking” (such taking being precluded under the treaty). Moreover, the Court considered that enduring captivity was justified by the need to conduct research pursuant to obligations under ASCOBANS. This is deeply perplexing, since ASCOBANS does not consider permanent captivity for research (or any other) purposes acceptable. The judgment remains highly unsatisfactory in the light of these and other treaty obligations, while the Court seemingly ignored evidence that the facility to which the orca had been transferred does not engage in substantive research into cetacean ecology.